Minnesota Title V MCH Needs Assessment Fact Sheets

Children with Special Health Needs

Adequate Insurance

Summer 2004

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Size of the Problem

According to the National Survey of Children with Special Health Needs conducted in 2001 and released in 2003, 68.8 percent of the children with special health needs in Minnesota have adequate insurance.[1]

  • 12,197 (7.6%) children with special health needs are uninsured at some point during any given year.
  • 3,100 (1.9%) children with special health needs have been uninsured for a year or more or have never had insurance.

According to the National Center for Health Statistics definition of "uninsured", an estimated 7,077 children with special health needs in Minnesota were uninsured on the date surveyed.[2]

Analysis of the Department of Human Services Supplemental Security Income extract Nearly 7% of SSI recipients under the age of 16 in Minnesota have no demonstrated health care coverage for at least three months.

More than 2,500 children with special health needs lost supplemental health coverage through the MCSHN Treatment/Evaluation Program when it ended in 2003.

  • 70% of families of children with special health needs surveyed through the MCSHN Section of the Minnesota Department of Health (n=1981) indicate a need for additional financial resources for their child.

Of those with insurance on the day surveyed through SLAITS Survey of Children with Special Health Needs (weighted estimate of 158,869):

  • 82% have private health care coverage
  • 21% are covered through Medical Assistance.
  • 7% have another type of health care coverage.

Adequacy of health care coverage:

  • An estimated 16,500 children with special health needs have health insurance benefits available that never or only sometimes meet their needs.

Out of Pocket Costs:

  • 82% of the families of children with special health needs have some out of pocket costs during the year.
  • 26% paid more than $500.00 for medical care in a year.
  • 11% paid more than $1,000.00 for the child's medical care in a year.
  • 1.6% paid more than $5,000.00 for the child's medical care in a year.
Insurance Type Special Health Needs No special Health Needs
MN Rank MN Percent US Percent MN Rank MN Percent US Percent
Private
10
71.4
64.7
3
80.9
70
Public
5
13.4
21.7
7
9.9
16.1
Both
11
10.7
8.1
36
3.5
4.7
Uninsured
22
4.4
5.2
14
5.2
8.7

Despite the presence and adequacy of health care coverage for the majority of children with special health needs in Minnesota:

  • The families of an estimated 23,602 (14.6%) children with special health needs contacted their child's health plan with a problem or complaint in a 12-month period.
  • 22% of the families would probably change or definitely change to another health plan if they could.

Seriousness

In the SLAITS survey on insurance, children with special health needs in Minnesota are somewhat more likely than their healthy peers to have insurance. Compared to other states, Minnesota is 14th in the percentage of uninsured children without special health needs and 22nd in the percentage of uninsured children with special health needs on the day interviewed.

Minnesota compares favorably to other states in relation to the adequacy of health care coverage for children with special health needs. Minnesota ranks 3rd nationally in the percentage of children with special health needs with adequate insurance. Only Hawaii (70%) and Rhode Island (68.9%) have higher percentages of adequately insured children with special health needs.

While most families surveyed agreed that costs for care not covered by insurance were reasonable, they were not asked if those costs were affordable. Cost was the most frequently cited factor for:

  • Children who didn't received needed specialty care (nearly 27%).
  • Children who didn't receive needed dental care (49%).
  • Children who didn't receive needed prescription drugs (45%).
  • Children who didn't received needed mental health services (45%).

Contacts with insurance companies regarding concerns or problems as well as a desire to change health plans if possible are possible indicators that attaining the goal of adequate coverage relies on the willingness / ability on the part of parents to advocate on their child's behalf. This type of follow-up at the very least requires time and energy therefore can increase the burden of care on already stressed families.

Interventions

There is a large body of research that is virtually unanimous in its conclusions about the impact of insurance on the health of children and adults. As stated both simply and succinctly by the Kaiser Commission on Medicaid and the Uninsured: "Health Insurance Matters".[3] As noted in the overview of that document, lack of insurance compromise's the health of individuals because they are less likely to receive preventive care, more likely to be hospitalized for avoidable health problems, less likely to receive timely diagnoses, and more likely to delay needed treatment.

In addition, lack of insurance also affects the financial well being of families by increasing family exposure and vulnerability to the high cost of health care and out-of-pocket costs. Nationwide, most uninsured children live in two parent families where at least one parent works full time.[4] Minnesota specific studies corroborate that most uninsured children have parents who are employed.[5] Surveys in 1999 and 2001 by the University of Minnesota, School of Public Health, Division of Health Services Research and Policy indicate the percentage of all Minnesotans who were uninsured was 5.3 and 5.4 percent respectively. Research by the Health Economics Program of the Minnesota Department of Health indicates that 95.5 percent of all Minnesota children under the age of 18 had health insurance coverage during 2002.[6] However, the same data indicate the rate was 84.1 percent for children in a household where income was $25,000 or less and the rate for white, non-Hispanic children was much higher than for non-white, or Hispanic children (96.6% vs. 90.9%).

Analyses by the same program of variations in utilization concludes "...that health insurance and having a usual source of care are associated with better health and improved health outcomes. Policy makers should continue to explore ways to ensure that Minnesotans have access to affordable, high quality health insurance coverage."[7]

Status

There is widespread community awareness, concern and advocacy for universal health coverage of children. The Cover All Kids Coalition was formed in 1999 and expanded in 2001 to promote universal coverage and utilization of preventive services for the state's children. Its membership includes over 75 organizations joining together for the purpose of promoting health insurance coverage and preventive care. Membership ranges from state agencies (including MDH and DHS) to professional associations (MN-AAP, MNA, MMA, MN-PNPs) to insurers to advocacy organizations to faith-based groups such as the Joint Religious Legislative Coalition.[8] In addition, the Robert Wood Johnson Foundation spearheads a national initiative to help eligible families enroll in public health care programs. In Minnesota the Children's Defense Fund of Minnesota as its Covering Kids and Families project manages this effort.[9]

All children with special health needs having adequate public/private insurance to meet their needs is one of the six core outcomes identified by the Maternal and Child Health Bureau.


1. Centers for Disease Control and Prevention, National Center for Health Statistics, State and Local Area Integrated Telephone Survey, National Survey of Children with Special Health Care Needs, 2001
2. Uninsured--Includes persons who have not indicated that they are covered at the time of the interview under private health insurance (from employer or workplace, purchased directly, or through a State, local government, or community program), Medicare, Medicaid, SCHIP, a State-sponsored health plan, other government programs, or military health plan (including VA, TRICARE, and CHAMP-VA). This category also includes persons who are only covered by the Indian Health Service or only have a plan that pays for one type of service such as accidents or dental care. For approximately 1% of respondents, coverage status of insured versus uninsured is unknown. Weighted frequencies indicate that 1% of the population under 65 years fell into this "unknown" category.
3. Kaiser Family Foundation. The Uninsured: A Primer-Key Facts About Americans Without Health Insurance. December, 2003.
4. Kaiser Family Foundation. Health Insurance Coverage in America 2002 Data Update. December, 2003
5. Minnesota Department of Health, Health Economics Program. Minnesota's Uninsured: Findings from the 2001 Health Access Survey. April, 2002
6. Minnesota Department of Health, Health Economics Program. 2002 BRFSS Child Health Module Data Book. March, 2004.
7. Minnesota Department of Health, Health Economics Program. Variations in the Use of Health Services in Minnesota by Insurance Status: Results from the 2001 Minnesota Health Access Survey. February 2004.
8. Children's Defense Fund. Cover All Kids Coalition at www.cdf-mn.org/CAKcoalition.htm [Attn: Non-MDH Link]
9. Children's Defense Fund. Covering Kids and Families at www.cdf-mn.org/CKAF.htm [Attn: Non-MDH Link]